[A case of possible elderly onset rheumatoid meningitis without arthritis]

Area of Science:

• Neurology
• Rheumatology
• Neuroimaging

Background:

• Rheumatoid meningitis is a rare complication of rheumatoid arthritis, affecting the central nervous system.
• Diagnosis can be challenging due to non-specific symptoms and the absence of overt joint involvement.

Observation:

• A 93-year-old male presented with disturbance of consciousness.
• Brain MRI revealed subarachnoid space hyperintensity in the left frontal and parietal lobes on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR).
• Pia mater gadolinium enhancement was noted, but biopsy was deferred due to high perioperative risk.

Findings:

• Elevated rheumatoid factors and anti-cyclic citrullinated peptide antibodies were detected, despite no physical signs of rheumatoid arthritis.
• The patient was diagnosed with suspected rheumatoid meningitis based on clinical, imaging, and serological findings.

Implications:

• This case highlights the utility of advanced neuroimaging techniques like DWI and FLAIR in diagnosing rheumatoid meningitis.
• Intravenous methylprednisolone treatment demonstrated efficacy, underscoring the role of steroid therapy in managing this condition.
• Early recognition and treatment are crucial for improving outcomes in patients with rheumatoid meningitis.